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I posted a learning opportunity, the review of Cope’s Acute Abdomen.

Here is a brief educational quote from the book:

Before entering into the detailed consideration of the various forms of acute abdominal pain, it is well to lay down certain principles that form the basis of all successful diagnosis in urgent abdominal disease.

Necessity of making a diagnosis

The first principle is that of the necessity of making a serious and thorough attempt at diagnosis, usually predominantly by means of history and physical examination.
Abdominal pain is one of the most common conditions that calls for prompt diagnosis and treatment. Usually, though by no means always, other symptoms accompany the pain, but in most cases of acute abdominal disease, pain is the main symptom and complaint. The very terms “acute abdomen” and ‘·abdominal emergency,” which are constantly applied to such cases, signify the need for prompt diagnosis and early treatment, not necessarily always surgical. The term acute abdomen should never be equated with the invariable need for operation. In some instances the urgent need for operation may be so obvious that the need for transference of the patient to the care of a surgeon is clear. In other cases, the observer may, if in doubt, think it wise to discuss the problem with a fellow practitioner before deciding on any course of action. There are, however, occasions when, with somewhat indefinite symptoms, there is justification to wait for the development of clearer indications to see whether the condition will not improve spontaneously and to temporize as long as the patient is carefully observed at frequent intervals. Though
in some cases it is impossible to be certain of the diagnosis, it is a good habit to come to a decision in each case; it will be found that after a short time, the percentage of correct diagnoses will increase rapidly.

 The New Medicine is a mess.  Nobody seems to have the skill nor the predilection to advance a diagnosis, even if it is an unproven element of a differential diagnosis (i.e. a list of possible diagnoses.)

I hear so many patients coming home with the two most lethal diagnoses from the ER – “I don’t know,” and “It’s nothing.”

By definition, an illness is a set of symptoms and/or signs.  A patient with symptoms – a headache, nausea & vomiting, dizziness – has SOMETHING. Whether it is benign, whether it is most likely a benign diagnosis, it still is SOMETHING.  A patient with “nothing” has no symptoms. It used to be an embarrassment, a rookie mistake, a third-year or intern’s blunder.